Neuroimaging of brain and vessels
Magnetic resonance imaging (MRI) and MR angiography (MRA) to:
 Exclude haemorrhage
 Define extent and territory of infarct
 Define vascular anatomy of circle of Willis and neck vessels
 T1 weighted spin echo with fat saturation sequence to exclude dissection
Computed tomography (CT) scan to exclude haemorrhage if MR not available acutely
Conventional angiography if haemorrhage without coagulopathy or MRA normal
For those with haemorrhage
Basic coagulation studies and platelets
Conventional angiography if no bleeding diasthesis
For those with no infarct
Electroencephalogram (unihemispheric slowing in hemiplegic migraine)
For those with an infarct in a vascular distribution and/or cerebrovascular disease
Precordial echocardiography
 Consider transoesophageal if normal (?same general anaesthetic as arteriogram)
 Consider transcranial Doppler ultrasound with bubble contrast
Blood tests (4 ml EDTA, 6–8 ml citrated, 2 ml heparinised, 5 ml clotted)
 Full blood count, differential white cell count, and erythrocyte sedimentation rate
 Iron, folate, red cell folate, and haemoglobin electrophoresis if appropriate ethnic group
 Protein S (total and free)2-150, and protein C2-150
 Antithrombin III2-150, heparin cofactor II2-150, plasminogen2-150, von Willibrand factor antigen,
factor VIII2-150, factor XII2-150,and lupus anticoagulant
  Anticardiolipin antibodies2-150
 Factor V Leiden and activated protein C resistance
 Prothrombin 20210 gene
 Total homocysteine2-150 (+ thermolabile methylene tetrahydrofolate reductase gene, serum folate, B6, and B12)
  Fasting cholesterol and triglycerides and Lp(a) lipoprotein
 Infection screen, includingMycoplasma, Chlamydia, Helicobacter, and Borrelia titres, and aspartate aminotransferase
 Serum and cerebrospinal fluid to look for intrathecal production of antibodies to varicella zoster
 Sleep study
For those with infarction in the territory supplied by the vertebrobasilar system (in addition)
x Ray cervical spine in flexion and extension
For those with infarction not in a typical vascular distribution
Cerebrospinal fluid lactate
Plasma ammonia and amino acids
Urine organic acids
  • 2-150 If performed acutely, must be repeated after 3 months.